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Breast pumps come in a variety of styles. Most important is that they breast
pump be safe, effective and comfortable. Always read the manufacturer’s
instructions before using your pump.
A healthy infant is far more effective at emptying the breast than any pump.
Remember, breastfeeding is a learned process. Be patient. It may take several
tries before you are comfortable and proficient.
Here are some basic tips to boos your breast pumping know-how:
* Always wash your hands before breast pumping.
* Use deep breathing techniques to relax and assist with let-down.
* Apply warm compresses to your breasts 10 minutes before pumping.
* Move the pump’s breast shield around to stimulate more milk ducts.
* If let-down is difficult, have a drink of water, juice or tea before or during
pumping.
Your ideal pumping time will depend on your baby’s schedule. If you want to
prepare a bottle, try pumping in the morning after feeding when milk is most
plentiful.
To maintain an adequate milk supply, frequent feeding or pumping is essential.
Milk supply may diminish over time, especially if your baby is ill. When he/she
begins breastfeeding again, however, milk production will increase.
Finally, remember to take good care of yourself! East a balanced diet, drink
plenty of fluids and get lots of rest.
Breastfeeding Your Baby
Breastfeeding is the most natural and nutritious way to encourage your baby’s
development. Attempts to improve upon nature’s miraculous feeding system have
been unsuccessful. Neither the nutrients found in the milk you produce nor the
special benefits these nutrients provide can be duplicated. Simply put, nature
does the best job of providing for your baby’s needs.
Our hope is that after considering the material presented in this booklet, you
will join thousands of other mothers who have chosen to breastfeed. As you will
see, the physiological and psychological rewards are many for both you and your
baby.
Advantages
Breastfeeding is the natural next step in the continuum of pregnancy. For the
past nine months, your body has been preparing a very special blend of nutrients
in the exact proportions your baby needs. Human milk is a unique combination of
fats, sugars, minerals, proteins, vitamins and enzymes, custom-made to promote
brain and body growth.
Colostrum is the perfect starter food for babies. This clear to creamy to
golden-yellow substance is found in the breasts during pregnancy. A few days
after baby’s birth, it begins the change to mature milk. Colostrum provides
unmatched immunity against bacteria and viruses, thus protecting vulnerable
newborns from a host of diseases to which they are exposed. In addition,
colostrum acts as a natural laxative to clear the meconium (first stool) from
the baby’s intestine, thus decreasing the chance of jaundice. Colostrum also
contains the natural sugar lactose, which helps stabilize the newborn’s blood
sugar level, preventing hypoglycemia.
The advantages of breastfeeding are plentiful, as colostrum is slowly replaced
by mature milk and baby continues to breastfeed. While cow’s milk and formula
mixtures can trigger allergic reactions and are often difficult for baby to
digest, your milk is perfectly designed specifically for your baby. Studies show
that breastfed babies have fewer ear and diarrhea infections; experience less
vomiting and acute respiratory illness; and are at lower risk for childhood
diabetes, lymphomas and Crohn’s disease. Even the activity of sucking at the
breast enhances the development of oral muscles and facial bones.
As an added bonus, breastfed pre-term babies tend to have a higher IQ than their
formula fed playmates.
Breastfeeding offers baby emotional as well as nutritional benefits.
Skin-to-skin contact helps to reduce the stress babies experience as the enter
the world from the security of the womb. Tension quickly subsides as baby is
comforted by the sight of the mother’s face and the familiar sounds of her
breathing, voice, and heartbeat. Thus begins the important process of
mother-infant attachment.
And baby isn’t the only one who benefits from the breastfeeding experience. When
baby is put to the breast immediately after birth, the resulting release of the
hormone oxytocin into mother’s system speeds delivery of the placenta and
constricts uterine blood vessels to minimize blood loss. Repeated release of
oxytocin through nursing causes the uterus to return to it’s pre-pregnancy size
quicker.
The milk-producing hormone, prolactin, is another wonderful by-product of
breastfeeding. Called the "mothering hormone", it have a releasing effect on
mother and stimulates maternal instincts. The ongoing production of milk burns
calories, helping you lost weight gained during pregnancy. And women who
breastfeed have been shown to have less incidence of pre-menopausal breast
cancer, cervical cancer and osteoporosis.
Add to these primary advantages the practical facts that your milk is always the
right temperature, absolutely fresh, perfectly clean, instantly available, and
you have the most nutritious, convenient feeding system there is-at the lowest
cost!
Before Baby Arrives
Though breastfeeding is natural, technique is a learned skill. It is important
to get started correctly, even before your baby is born. You need to know well
in advance how to identify and avoid possible problems, and where to turn if
difficulties do arise. Most breastfeeding problems occur during the first few
weeks as you and your baby begin establishing your nursing patterns. With proper
and prompt attention, the majority of these difficulties disappear as quickly as
they develop.
Plan to learn as much as you can about breastfeeding. You will be making an
important investment in you and your baby’s continued good health. Reading this
booklet is a wonderful start! You may also choose from an abundance of valuable
reference materials. Several excellent books on breastfeeding are listed in the
last section of this booklet.
Also available is an informative, beautifully directed videotape co-produced by
Medela and La Leche League International (pronounced La Lay-Chay League). For
more personalized instruction, plant to attend La Leche League (LLL) meetings or
prenatal breastfeeding classes given in conjunction with your childbirth
education series or by a lactation consultant.
The most important contact before and during your breastfeeding experience will
be with certified lactation consultants and/or support organizations such as La
Leche League International and the Nursing Mothers’ Council. By attending League
meetings, for example, you will have the opportunity to meet and compare notes
with other breastfeeding mothers. As your questions are answered, you will
receive the helpful tips and reassurance you need to make your breastfeeding
experience even more rewarding.
As with any skill, the keys to successful breastfeeding are practice and
patience. Learn all you can and then surround yourself with people who will
offer you the encouragement you need. Be easy on yourself. Relax and enjoy this
special and wondrous experience.
A Simple Nipple Test
To determine if your nipples are flat or inverted, simply place your thumb and
index finger on the areola, the dark area surrounding the nipple. At the base of
the nipple, compress gently but firmly. If you nipple flattens or retracts
(inverts) into the breast, you can begin wearing breast shells during the last
couple of weeks of pregnancy. These plastic shells are worn under a bra and
create slight pressure at the base of the nipple, drawing it out. It is
important to do this "pinch test" because although some nipples appear erect,
they may invert when the areola is compressed.
After birth, if baby still has difficulty attaching to your breast, contact a
lactation consultant, LLL Leader, or the Nursing Mothers’ Council.
How Your Breasts Produce Milk
Milk is produces and stored in the glandular tissues (alveoli) of your breasts.
It collects in pockets (lactiferous sinuses) located beneath the areola until it
is released by a baby’s sucking. Stimulation of the nipples causes the mother’s
pituitary gland, located in the bran, to secrete prolactin, which initiates and
maintains milk production. The first milk your baby receives at each feeding is
the milk that has collected in the pockets between feedings. This low-fat
foremilk is high in protein and satisfies the baby’s thirst. As breastfeeding
continues, a second hormone called oxytocin is secreted. Oxytocin causes the
tissue around the alveoli to contract, thus squeezing the high-fat hindmilk down
the ducts and into the pockets where it is available to satisfy your baby’s
hunger.
Many mothers experience a tingling or rushing sensation in the breasts as this
"let-Down" or milk ejection reflex (MER) occurs. Other mothers notice only that
sucking becomes longer and slower, and that baby begins to swallow rhythmically.
Keys to establishing a quick let-down are relaxation and confidence that your
body is doing exactly what it was designed to do: feeding your baby the world’s
best baby milk – products by you!
Breastfeed Immediately
Successful breastfeeding is the combined result of practice, patience, and
proper positioning. Breastfeeding as soon as possible-preferably within an hour
after birth-will get both of you off to a good start. Keeping your infant with
you during your hospital stay will help you get to know and immediately respond
to his cues. In addition to beginning the important cycle of milk supply and
demand, early breastfeeding allows your baby to receive the benefits of
colostrum. Rich in nutrients and antibodies, colostrum is the first milk you
produce and is your baby’s perfect starter food.
Immediately after birth, your baby will be in a quiet alert state and generally
receptive to breastfeeding. (If your baby isn’t ready the very first time you
try to breastfeed, try again within the next half-hour or so.) Within a couple
of hours, your baby will become quite sleepy; drowsiness may last for several
days.
Avoiding Artificial Nipple Preference/Confusion
Your Baby begins to learn and practice the correct breastfeeding suck with the
very first nursing experience. When both breasts and bottle are offered in the
early days, your baby may become nipple confused or may simply prefer the bottle
nipple. Breastfeeding is a process for the baby; bottle-feeding, however, is
passive and requires a different type of suck. A baby who is bottle-fed early
can have difficulty transferring to the breast. Avoid using any rubber teat
(nipples) or pacifiers (soothers, dummies) during the first weeks. If your baby
needs supplementation for a medical reason, use a cup. Yes, even a tiny baby can
drink from a small medicine or paper cup!
The Law of Supply and Demand
Milk production works on the principle of supply and demand. The more your baby
breastfeeds, the more milk you will produce, totally meeting your baby’s needs.
It is the frequency of breastfeeding as well as the milk removed from the breast
that stimulates further milk production. Babies who are given supplemental
bottles of water or formula breastfeed less frequently, ultimately decreasing
the milk supply. Supplements, unless medically indicated, should be avoided for
three to four weeks, until your milk supply is well-established and your baby is
latching on to the breast without difficulty. Babies need to be breastfed at
least 8 to 12 times in 24 hours the first 2 to 4 weeks, or until well above
birth weight.
Attaching Baby to The Breast
Latching the baby on correctly is the key to a pleasant, rewarding breastfeeding
experience. Nursing behavior patterns are established early. One set, bad habits
are difficult to correct. Make sure you and your baby get off to a good start. A
variety of reading materials and videos are helpful, but there is nothing like
hands-on assistance from an experienced healthcare provider. Don’s hesitate to
ask for help the first few times. If you are still having difficulty by the time
you leave the hospital, contact a lactation consultant or a LLL Leader.
Step 1
For most women, sitting up in bed or in a comfortable chair is easiest for
breastfeeding. Make sure you are relaxed before you put your baby to the breast.
Use pillows on your lap, under your arms and behind your back. Putting your feet
on a footstool to raise your knees slightly above your hips will eliminate back
strain and put your body at the right angle. The Nursing Stool from Medela is a
footstool designed especially for breastfeeding. If you do not have a stool, use
a thick telephone book or an overturned wastebasket.
Make sure your baby is comfortable and feels secure and supported. Nestle the
baby in your arm at the level of your breast. The baby should be turned toward
you, chest to chest, his head and trunk in a straight line, so that he doesn’t
have to strain or turn his head to attach to the breast. Tuck the baby’s lower
arm into the pocket betw4een the two of you; if necessary, hold his upper arm
down gently with the thumb of your supporting hand. Be careful not to tilt the
baby’s head down, as it will be difficult for him to swallow in that position. A
very slight extension of the baby’s head, with his chin touching your breast,
will help keep his nose clear without your having to press on your breast
tissue.
Step 2
Hold your breast with your fingers underneath and thumb on top, making sure all
of your fingers are placed well away from the areola. It is sometimes helpful if
you roll your nipple between your fingers for a couple of seconds to help it
become more erect. Then manually express a couple of drops of colostrum to
entice the baby to take the breast. A woman with large breasts may find it
comfortable to help support the weight with a follows washcloth or diaper under
the breast.
Step 3
Gently tickle the baby’s lower lip with your nipple to encourage him to open his
mouth wide. The moment he opens wide, almost like a yawn, quickly pull him in
close to you. Do not lean forward, trying to put your breast into the baby’s
mouth. Instead, pull the baby toward you so that he has a large mouthful of
breast tissue. His chin should be pressing into your breast; his nose should be
just touching your breast. Keep supporting your breast with your hand until the
baby is latched on and is sucking well. Women with large breasts may have to
support their breast throughout the entire feeding; smaller breasted women may
not need to do this.
The key to successful latch-on and preventing nipple soreness is teaching your
baby to take a large portion of the areola into his mouth.
As mentioned earlier, your milk collects in the pockets located beneath the
areola. To empty these reservoirs effectively, the baby’s mouth must be position
over them. If the baby sucks only on the nipple, little milk will be drawn out,
and you will become quite sore. If your baby doesn’t latch on properly right
away, continue to encourage him to open his mouth wide and then pull him close
to you again. Don’t be afraid to repeat these steps several times until your
baby gets the idea.
If you feel any pain after your baby starts sucking rhythmically, stop, and
break the suction by inserting your finger into the corner of his mouth between
the gums. Then try again. Latch-on discomfort is common in the first week or
two, but any pain should subside in a few seconds. Take a deep breath, relax,
and enjoy breastfeeding! You may even find yourself drifting off to sleep-a good
sign the prolactin and oxytocin are flowing. Grab a little catnap while you are
at it!
Breastfeeding Styles
Just as babies have different personalities, so too do they exhibit a variety of
breastfeeding styles. Some babies latch-on and start sucking immediately,
getting right down to business. Others take the slow and easy approach, simply
enjoying this special time with mom. Breastfeeding is not only a mode of
providing nutrition, it is also a special way of nurturing your baby. Although
the terms "breastfeeding" and "nursing" are used interchangeably, breastfeeding
could be used to describe the nutritive sucking that your baby does while
feeding. Nursing describes the non-nutritive, sleepy type of suck your baby does
when simply relaxing and enjoying being at the breast. Nutritive sucking is a
slow, long, drawing, rhythmic sucking accompanied by swallowing. Non-nutritive
sucking is lighter, faster, and less intense. Swallowing is minimal or absent.
Babies will often suck quickly and intensely at the breast when they first
attach, a sort of "priming the pump" to initiate the let-downs before they
settle into the rhythmic deep sucking that characterizes breastfeeding.
Burping
In the very early days of breastfeeding, most babies will swallow little or no
air and may not burp at all after feeding. Breastfed babies generally swallow
less air than bottle-fed babies. After your baby has finished feeding on one
side, burp him before offering the other side. Remember, effective burping
techniques require placing firm pressure on your baby’s tummy. Lean the baby’s
weight against the heel of your hand as he sits on your lap, or drape him over
your shoulder or on one knee, and firmly pat or rub his back. If your baby
doesn’t burp in a minute or so, don’t worry; just continue with his feeding.
Rooming – In With Your Baby
Mothers and babies belong together after birth, and rooming-in is one of the
best ways to accomplish this. Most hospitals have facilities that allow mothers
and babies to stay together during the postpartum period. What a wonderful
opportunity to get to know and care for your baby! In fact, studies have shown
that babies who stay with their mothers are better breast feeders, cry and
startle less often, feed more frequently, and are less uncoordinated in their
sucking than babies cared for in central nurseries. They also seem to establish
their day-night rhythms quicker. In addition, mothers who room-in with their
babies exhibit a lower incidence of postpartum depression. Rooming-in lets you
start learning how to respond to your baby’s cues. In turn, your baby will learn
how to use cues more effectively, confident that his efforts will be rewarded
with a response.
Working and Breastfeeding
In addition to understanding and mastering the art of breastfeeding, working
mothers face added challenges imposed by their schedules. Growing support by
employers and a variety of innovative aids are making breastfeeding a viable
option for mothers who work outside the home.
First and foremost, take full advantage of your maternity leave to establish a
good supply of milk before going back to the job. The longer you can stay home
and concentrate on breastfeeding your baby, the easier it will be to maintain
your milk supply after you go back to work. Fatigue is a working mother’s
biggest enemy, regardless of how you choose to feed your baby. One of the ways
to minimize fatigue in your first few weeks back is to return to work on a
Thursday rather than on a Monday. If possible, take the nest two Wednesdays off,
so that you aren’t working more than two days in a row. This schedule will get
you back into the swing of things slowly, giving both you and your baby a bit
more time to adjust to the change in routine.
A carefully chosen breast pump will enable you to collect and store your milk at
work for feedings you will miss at home. Automatic-cycling, hospital-type
electric pumps provide a safe, fast, efficient way to express milk from the
breasts. Care should be taken to select a quality product that simulates the
baby’s suck-release-relax cycle as closely as possible. These units may be
rented from one of thousands of rental stations throughout the United States. To
locate the rental station in your are, call the Breastfeeding National Network (BNN)
line at 1-800-TELL YOU or Medela at 1-800-435-8316.
Manual pumps offer the advantage of small size and portability; a third
alternative, hand expression, requires no special pumping equipment.
Recipe for Working Mothers
It is especially important for working mothers to remember that milk production
is based upon the principle of supply and demand. The key to maintaining a
sufficient milk supply is to breastfeed often.
If your baby is under four months old, you should express your milk during the
work week when your baby would breastfeed if you were home. Additionally, you
should breastfeed in the morning just before going to work, again as soon as
possible after work, frequently during the evening and whenever baby wakes at
night. Breastfeeding at night causes your prolactin level to rise, thus helping
you to relax and enjoy a good night’s sleep. On weekends or days off, breastfeed
your baby as often as possible. Keep in mind that it isn’t unusual for your milk
supply to drop toward the end of the work week. Breastfeeding as much as
possible and luxuriating in the rest that it provides, will help increase your
supply for the next week. When the baby is four months old, you can probably
reduce the number of pumping to one or two times during your working hours.
Some companies offer on-site breast pumps and access to lactation professionals.
Double Pumping
Double pumping kits offer time-saving benefits by allowing you to express both
breasts simultaneously. By cutting pumping time virtually in half, you can
successfully complete a pumping session during a regular break period (15
minutes). In addition, research indicates that double pumping may increase
prolactin levels, your milk producing hormone. This unexpected side benefit is
important to working mothers and mother or preterm infants who may have
difficulty maintaining and increasing milk supply when the baby isn’t available
for breast stimulation. Mothers experience in using double pumping can learn
single-hand techniques for even easier pumping.
Storing Breast milk
Human milk varies in color, consistency and odor, depending on the mother’s diet
and storage container used. Because breast milk is not homogenized, the cream
will separate and rise to the top of the container. Breast milk may be safely
stored by carefully following these steps:
1. Wash your hands well with soap and water before touching your breasts or any
milk containers. Avoid touching the inside of bottles or caps.
2. Pump or express milk into a clean collection cup.
3. Transfer the milk into a clean storage container. If you can pump directly
into a storage container, such as a Medela CSF bag, it will lessen the chance of
contamination.
4. Label the container with the date and amount of milk collected; be sure to
use the oldest milk first.
5. To inhibit the growth of bacteria, breast milk, which is not used
immediately, should be refrigerated, or if stored for more than 24 hours,
frozen. Check with your hospital for specific storage instructions.
6. For longer storage, freeze your breast milk. Frozen milk may be stored in a
refrigerator freezer for six months or in a deep freeze (-20 C) for up to 12
months.
Fill the container only ¾ full to allow room for expansion during freezing.
Freeze the milk in 2oz. to 4oz. Portions. These smaller amounts will thaw
quicker. If your baby doesn’t drink the entire portion, there is less waste. It
is possible to combine fresh milk with frozen milk. To prevent premature
thawing, always cool milk before combining it with previously frozen milk. The
amount of newly added milk must be less that the amount of milk already frozen.
Never refreeze breast milk.
Thawing Frozen Breast milk
1. Place the sealed container of milk in a bowl of warm water for about 30
minutes, or hold the container under warm running water. Never microwave breast
milk; micro waving can alter the composition of the breast milk and result in
burning your baby.
2. Swirl the container to blend any fat that my have separated and risen during
thawing.
3. Feed thawed milk immediately or store in the refrigerator for a maximum of 24
hours.
Traveling With Breast milk
When caregivers take bottles of breast milk along on outings, milk should be
kept cold until feeding time to ensure that it will be fresh and safe for your
baby. The cooler in the Medela Lactina Accessory Kit and the Medela Cooler Case
are ideal for this purpose.
Manual Express of Breast milk: Marmet Technique
Draining the Milk Reservoirs
1. Position the thumb (above the nipple) and first two fingers (below the
nipple) about 1" to 1 ½" from the nipple, though not necessarily at the outer
edges of the areola. Use this measurement as a guide, since breasts and areolas
vary in size from one woman to another. Be sure the hand forms the letter "C"
and the finger pads are at 6 and 12 o’clock in line with the nipple. Note the
fingers are positioned so that the milk reservoirs lie beneath them.
* Avoid cupping the breast.
1. Push straight into the chest wall.
* Avoid spreading the fingers apart.
* For large breasts, first lift and then push into the chest wall.
3. Roll thumb and fingers forward at the same time. This rolling motion
compresses and empties milk reservoirs without injuring sensitive breast tissue.
Note the position of thumb and fingernails during the finish roll as shown in
the illustration.
4. Repeat rhythmically to completely drain reservoirs.
* Position, push, roll….position, push, roll….
4. Rotate the thumb and fingers to milk other reservoirs, using both hands on
each breast.
Avoid These Motions
1. Do not squeeze the breast, as this can cause bruising.
2. Sliding hands over the breast may cause painful skin burns.
3. Avoid pulling the nipple which may result in tissue damage.
Assisting the Milk Ejection Reflex
1. Massage the milk producing cells and ducts by pressing the breast firmly with
the flat of the fingers into the chest wall, beginning at the top. Move fingers
in a circular motion, concentrating on one spot at a time for a few seconds
before moving on to another spot. Spiral around the breast toward the areola as
you massage. The motion is similar to that used in a breast examination.
2. Stroke the breast area from the top of the breast to the nipple, using a
light tickle touch. Continue the stroking motion to help you relax, which in
turn will stimulate the milk ejection reflex.
3. Shake the breast while leaning forward so that gravity will help the milk
eject.
Procedure
This procedure should be followed by mothers who are expressing in place of a
full feeding and those who need to establish, increase, or maintain their milk
supply when the baby cannot breastfeed.
* Express each breast until the flow of milk slows down.
* Assist the milk ejection reflex (massage, stroke, shake) on both breasts. This
can be done simultaneously.
* Repeat the whole process of expressing each breast and assisting the milk
ejection reflex once or twice more. The flow of milk usually slows down sooner
the second or third time, as the reservoirs are drained.
Timing
The entire procedure should take approximately 20-30 minutes.
* Express each breast 5-7 minutes.
* Massage, stroke, shake.
* Express each breast 3-5 minutes.
* Massage, stroke, shake.
* Express each breast 2-3 minutes.
NOTE: If the milk supply is established, use the times given only as a guide.
Watch the flow of milk and alternate breasts when the flow gets small.
NOTE: If little or no milk is present yet, follow these suggested times closely.
Special Circumstances
There are a number of special breastfeeding circumstances that may require added
patience. Mothers of adopted babies fall into this category. With instruction
and patience, they too may be able to breastfeed. The important point to
remember in all of the following cases is that breastfeeding is possible.
Lactation consultants and LLL Leaders are a great help in these situations.
* Premature/Sick Infants:
* If your baby is unable to breastfeed immediately after birth due to physical
problems or illness, you must express your milk to initiate and maintain a good
milk supply until your baby is able to breastfeed. Your expressed milk can be
stored and fed to your baby by gavage feeding, cur or finger feeding, or bottle.
Low-Weight-Gain Infants:
* Occasionally, breastfeeding babies fail to put on weight at an acceptable
rate. In these cases, it is important to have your baby evaluated by a physician
and a lactation consultant to discover the reason for the low weight gain. If
supplemental feedings are required, the Supplement Nursing System (SNS) from
Medela offers the benefit of nutritional support while avoiding the problem of
nipple confusion/preference associated with bottle feedings. Cleft Lip/Palate:
* Although your cleft-palate baby will have difficulty in sucking effectively,
it is possible for you to breastfeed. You will probably need to pump your
breasts after each feeding to keep up your milk supply and to supplement your
baby’s diet. Feedings, regardless of whether they are breast or bottle, will
take longer than usual; but it is important not to get discouraged. Twins:
Your body’s amazing ability to respond to the law of supply and demand will
enable you to breastfeed twins successfully. You will want to be comfortable
feeding them separately, so each has private time with you. There will be many
times, however, when it will be easier to nurse them simultaneously. Many
mothers of twins report that breastfeeding is actually easier than bottle
feeding!
In all these special cases, it is important to have routine checkups with your
baby’s doctor to ensure the infant’s normal, healthy growth. It is also
advisable to work with a lactation consultant or LLL Leader who is trained to
handle special breastfeeding challenges.
Common Problems
* Engorgement:
During the first week after delivery, as colostrum is changing to mature milk,
your breasts will become full. This normal postpartum fullness usually
diminishes within three to five days. Engorgement may develop if your baby does
not adequately remove the milk from your breasts. During this time, your breasts
will feel hard, painful, and hot. The fullness is due in part to extra blood,
lymph and swelling, not entirely to accumulated milk. Excessive fullness of the
breasts can also lead to swollen areolas and flattened nipples, making it
difficult for the baby to latch on and subsequently causing sore nipples.
You can prevent engorgement by:
* Breastfeeding your baby frequently-8-12-time in 24 hours
* Avoiding supplements of water or formula for the first 3 to 4 weeks unless
medically indicated.
* Expressing your milk if you miss a feeding.
* Weaning your baby gradually.
If you do become engorged:
* Apply warm, moist compresses to the breast for a few minutes just prior to
breastfeeding. Avoid any additional heat to the breast as this brings more blood
to the area increasing swelling.
* Hand express to soften the areola before breastfeeding. Gently massage your
breasts before and during breastfeeding.
* If your baby is unable to latch on, you will need to express your milk. In
this case, using a hospital-type electric pump is best.
* After breastfeeding or pumping, try using icy cold compresses on the breasts
to relieve discomfort and decrease swelling.
* Wear a good fitting, supportive bra.
* If you have further problems, contact you lactation consultant of LL Leader.
* Sore Nipples:
Some mothers will experience nipple tenderness for the first few days when baby
starts nursing. This latch-on discomfort should disappear as soon as the baby
begins rhythmic, nutritive sucking. Pain after this initial discomfort generally
indicates that the baby is not attached to your breast correctly. Incorrect
latch-on and/or improper positioning not only causes sore nipples, but can
contribute to ineffective emptying of the breast as well. If you have blisters,
cracking, burning, bleeding, and/or pain throughout the entire feeding or
between feedings, it is recommended that you talk with a lactation consultant,
LLL Leader, or the Nursing Mothers’ Council.
You can prevent sore nipples by:
* Positioning your baby correctly at the breast, chest to chest, so that both of
you are comfortable.
* Breastfeeding your baby frequently, 8 to 12 times in 24 hours.
* Making sure your baby opens his mouth wide and attaches properly to the breast
with his mouth well behind the nipple on the areola.
* Releasing the baby’s suction prior to taking him off the breast.
* Gently patting your nipples dry after each feeding.
* Expressing a little breast milk onto the nipples and massaging it into the
nipples and areola.
* Massaging in a small amount of USP Modified Lanolin if your nipples are dry.
* Avoid using soap on the breasts or nipples; soap can remove natural protective
oils. Water is all you need to clean your breasts when you bathe.
* Limiting the amount of time your baby sucks non-nutritive during the first few
weeks.
You can manage sore nipples by:
* Determining the cause of soreness by contacting a lactation consultant, LLL
Leader or the Nursing Mothers’ Council.
* Using deep breathing, soft music, or other relaxation techniques before and
during breastfeeding.
* Limiting feeding time on the sore nipple.
* Breastfeeding on the least-sore side first.
* Expressing a little milk to stimulate let-down. (Also express if the breasts
become engorged.) Expressing makes the areola softer, the nipple more erect, and
latch-on easier.
* Using nonplastic-lined bras, and/or bra pads. Change the pads frequently to
keep the nipples dry.
* Using a little USP Modified Lanolin on the nipples if they become dry or
cracked. The lanolin forms a moisture barrier so nipples stay dry.
* Using Medela breast shells to keep clothing and west nursing pads off the
nipple to prevent further irritation.
* Inadequate Milk Supply:
Most mothers will produce a sufficient milk supply if they breastfeed their baby
often and long enough. If your baby does not regain his birth weight by three
weeks, or is gaining very slowly, it is possible your milk supply is low.
Contact a lactation consultant or LLL Leader to determine the reason for your
low milk supply. Medela’s SNS may be helpful if your baby needs supplementation.
The system will provide appropriate breast stimulation while you are
supplementing, which will help increase your milk supply. It might be helpful to
keep a breastfeeding diary for the first four to five days after delivery.
Questions
* When will my milk come in?
Mature milk production begins about 30 hours after delivery, but may not be
evident for two to five days. Timing varies depending on you baby’s ability to
latch on properly and how frequently and effectively your baby sucks. Generally,
the more babies you have had, the sooner your silk "comes in." Keep in mind that
until mature milk is present, your baby is receiving rich colostrum, which has
three times the protein of mature milk and is just right for meeting your baby’s
needs during those first few days.
* How often (and long) should I feed my baby?
Babies need to be nursed as often as they indicate a desire to breastfeed. Watch
for your baby’s cues. Rooting, brushing a hand across his face, or making little
sucking motions are all indications that it is time to breastfeed. Babies will
demonstrate feeding cues for up to 30 minutes before they start crying. Crying
can cause your baby to have an uncoordinated suck, making it more difficult to
initiate feeding.
Most babies need to breastfeed at least 8 to 12 times in 24 hours for the first
few weeks. Once you and your baby are synchronized, the frequency and duration
of feedings per day will decrease. This process takes about six weeks, just
about the length of time it takes for you to completely recover physically from
the birth process! Let your baby breastfeed as long as he wants to on the first
breast; he’ll let you know when he Is finished, either by spontaneously coming
of the breast or by drowsily moving into non-nutritive "nursing." You can burp
the baby and offer the other breast. If your baby takes it, fine; if not, that’s
fine too.
There aren’t any "rules" about having to take both breasts at a feeding. The
next time the baby is ready to feed, you can offer the side he finished on or
didn’t take. Keep in mind that sometimes babies love to be put to the breast
simply for closeness and comfort, not because they are necessarily hungry.
Generally speaking, most babies will breastfeed every 1 ½ to 3 hours for 5 to 15
minutes per breast.
* Does my baby need bottles?
Giving your baby supplemental bottles in the early days may lead to nipple
confusion/preference and can adversely affect your milk supply. Unless you are
advised to do so for a medical reason, you should not give a breastfeeding baby
bottles or water or formula for the first 3 to 4 weeks. If supplementation is
necessary, it can be done with a small medicine spoon or a cup. Giving bottles
every day or every other day so your baby "gets used to taking a bottle" is not
necessary. After the first few weeks, giving him a bottle of expressed breast
milk periodically, when it is convenient for both of you, is all you need to do.
If your baby balks at taking a bottle, you can always feed him using a small cup
or a medicine spoon.
* What if I don’t have enough milk or my baby is gaining weight poorly?
Most delays in milk production result from an upset in the supply and demand
balance. Avoid giving supplemental bottles. Temporarily postpone your other
commitments to focus your energies toward establishing a breastfeeding routine
with your baby. Try these methods for increasing milk productions:
* Take your baby to bed with you. Nap-and night-nursings are time-tested
remedies for enhancing a baby’s weight gain.
* Remember the law of supply and demand, and increase the frequency of feedings
to at least one every two to three hours. Wake your baby during the day if he
sleeps more than three hours. Even a sleepy baby will nestle at your breast and
stimulate milk production.
* Look at, caress, and groom your baby as he breastfeeds. These maternal
behaviors stimulate milk production.
* Undress your baby before feeding to allow skin-to-skin contact. This action
may help awaken sleepy babies and stimulate less enthusiastic nursers.
* Watch for your baby’s feeding cues and capitalize on the times that he seems
ready to eat.
* Don’t try to wake your baby from a deep sleep; wait until he is in a light
sleep or drowsy state.
* Try "switch-nursing" to encourage more enthusiastic breastfeeding if your baby
seems to fall asleep quickly. Also called the "burp and switch" method,
switch-nursing allows your baby to feed on the first breast until his suck
diminishes and his eyes begin to close. Take the baby off your breast, burp him
and latch him on to the other breast. When sucking diminishes, take him off,
burp and switch again so he nurses at least twice on both sides.
* Double-nursing is another effective method for increasing the volume and fate
content of your milk. Feed your baby until he is content; keep him upright
instead of putting him down to sleep; burp him well, and 10 to 20 minutes later,
breastfeed him a second time. Be sure to keep him upright for 10 to 20 minutes
after a feeding to allow the trapped air bubble to be burped up, leaving room
for a "topping off."
Above all, relax during breastfeeding to permit an effective milk ejection
reflex. Seek the support of breastfeeding and mothering organizations such as
LLLI or contact a lactation consultant.
* How do I know if my baby is getting enough milk?
After the first month or so, you will intuitively know that your baby has been
satisfied by his heavier look and weight. In the first few weeks, it is not as
easy to tell, particularly for first-time mothers. Here are some signs to look
for:
* Your baby will have 6 to 9 wet cloth diapers (4 to 5 disposable diapers) and 2
to 5 (or more) bowel movements every 24 hours. The color of the stools can vary
from yellow to tan with a mustard-like consistency. Urine should be pale yellow
to almost clear in color.
* Your breasts may feel full before a feeding, less full after. You may leak
between feedings or leak on one side while feeding on the other.
* You will feel your baby sucking vigorously and hear him swallowing. Many
mothers (though not all) feel a tingly or pinchy sensation with the milk
ejection reflex. Often baby will drift off to sleep at the breast after a
vigorous feed, a good indication that he is satisfied.
Sometimes a baby will seem satisfied at the breast, but when he is put down,
will start to fuss and root again. This behavior is not necessarily an
indication that your milk supply is inadequate. Your baby may simply enjoy being
held and cuddled. And not want to give it up for a crib or an infant seat. Using
a baby sling during the day will keep him cuddled next to you while you go about
your daily routine.
* Why does my baby want to nurse all the time?
Your baby will breastfeed more frequently in response to sudden growth spurts.
Babies can grow as much as ½ inch in a 24-hour period. No wonder they need to
breastfeed frequently for several days! Breastfeed as frequently as your baby
indicates a desire. Your milk supply will soon catch up to his increased needs.
Giving bottles of formula at this time will only sabotage the natural supply and
demand cycle, and you will be unable to catch up with you baby’s needs.
Some babies love to be held and nursed frequently as a way of helping them to
adjust to life outside the womb. In fact, the first three to four months of life
for all babies is a transition from the womb to the world. During "increased
appetite" days, set aside other commitments to focus your energies on your baby.
Sleep when your baby sleeps to recharge your system after these high-need
periods. "Wearing" your baby in a sling or front carrier may be helpful. Just as
a toddler needs a periodic hug and kiss to make the world right again, a newborn
may need to be cuddled and even nursed for a while. As babies get older, they
learn other ways of self-comforting, and breastfeeding sessions generally become
shorter and less frequent.
* What diet should I follow while breastfeeding?
There are not "rules" to follow about your diet. A healthy, well-balanced diet,
high in protein and complex carbohydrates, similar to the one you consumed
during pregnancy, is all that is necessary. Because a lactating woman is
extremely energy efficient, there is no need for extra calories. Drink water or
other beverages when you are thirsty; eat when you are hungry. Lose weight by
avoiding high-calorie/low-nutrition snacks. Control your weight through regular
exercise rather than crash diets, which can present health risks to both you and
your nursing baby. If you must diet while breastfeeding, contact your lactation
consultant, physician, LLL Leader, or the Nursing Mothers’ Council for
specifics.
* Are there foods to avoid while breastfeeding?
Although you will get plenty of unsolicited advice about dietary restrictions
while you are breastfeeding, there aren’t any foods that a mother should
routinely avoid. Babies can be fussy and can have excess gas-just because babies
are fussy and babies have gas, not because you had broccoli for dinner last
night. Occasionally, a baby may be sensitive to something in the mother’s diet.
The most common sensitivities are to protein antigens that are found in cow’s
milk, soy, wheat, fish, corn, eggs, and nuts. If you believe your baby is
reacting to something in your diet, eliminate that food for two to three weeks,
then try it again. Generally speaking, you should east a healthy, well-balanced
diet, with no restriction. Any food (even chocolate!) in moderation is usually
fine. If your baby continues to be unusually fussy and gassy, contact a
lactation consultant, LLL Leader or the Nursing Mothers’ Council.
* What about breastpumps?
Breastpumps are helpful in stimulating, maintaining and expressing milk in cases
involving working or engorged mothers, and premature or sick infants.
Breastpumps are available in a variety of types, depending on your preferences
and needs. For a rental station in your area, call Medela’s Breastfeeding
National Network (BNN) at 1-800-TELL YOU.
* I’m a tense person. How can I relax better during nursing?
While the milk-producing hormone prolactin has a natural relaxing effect on the
breastfeeding mother, sometimes additional help is needed. The Medela audiotape
Breastfeeding Your Baby, includes specific relaxation techniques that will help
improve your milk ejection reflex. Setting up a special "breastfeeding station"
in your home may help create an environment in which you can unwind.
Select a comfortable chair (a big easy chair or rocking chair with arms is
nice), and a footstool to raise your lap . Surround yourself with everything you
might need: pillows, telephone, books, nutritious nibbles, juice, water, and
extra diapers. Try relaxing to soothing classical music or use the relaxation
techniques you learned in your childbirth class or on the Medela cassette. If
you have a toddler who demands your attention, set up your nursing station on
the floor or in the child’s room. Include an assortment of pastime supplies for
him, such as special toys, snacks, books, and music.
* When should I wean my baby?
Around the world, babies are breastfed an average of two to three years. There
is, however, no "right" time to wean. Weaning is an individual decision for each
mother and baby. Most babies will not show signs of wanting to wean before eight
to nine months at the earliest. The American Academy of Pediatrics recommends
breastfeeding exclusively for the first four to six months, gradually
introducing new foods after that time. Breast milk for at least a year is
preferred, using formula if your wean before that time. When you or your baby
decide to wean, you should do so gradually to prevent the discomfort of
engorgement and to help maintain your baby’s sense of security. Dropping one
feeding every few days and replacing it with formula or cow’s milk (depending
upon your baby’s age), will allow your breasts to adjust to the decreased demand
in comfort. Most mothers drop the late night or early morning feeding last as
this feeding is often a special snuggle time with the baby
Source :
http://www.brashop.com/html/breastfeeding%20.htm